PATENT APPLICATION FEE DETERMINATION RECORD
Effective October 1 , 2001
Application or Docket Number
10 55? '?55oo /
CLAIMS AS FILED - PART I
TOTAL CLAIMS
11 111113
FOR
NUMBER FILED
NUMBER EXTRA
TOTAL CHARGEABLE CLAIMS
<3 3 minus 20=
INDEPENDENT CLAIMS
£ minus 3 =
* 3
MULTIPLE DEPENDENT CLAIM PRESENT
□
* If the difference in column 1 is less than zero, enter "0" in column 2
CLAIMS AS AMENDED - PART II
(Column 1)
(Column 2)
(Column 3)
ENTA |
CLAIMS :
REMAINING
AFTER !
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
2
o
z
Total
*
Minus
**
LU
2
Independent
*
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
□
(Column 1)
(Column 2)
(Column 3)
ENTB |
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
2
Q
Total
Minus
**
LU
2
Independent
Minus
<
FIRST PRESE
NTATION OF MULTIPLE DEPENDENT CLAIM
□
(Column 1)
(Column 2)
(Column 3)
ENTC |
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
i PAID FOR
PRESENT
EXTRA
2
Q
Z
Total
*
Minus
**
LU
2
Independent
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
p
SMALL ENTITY OTHER THAN
TYPE I I OR SMALL ENTITY
RATE
FEE
RATE
FEE
BASIC FEE
370.00
OR
BASIC FEE
740.00
X$9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
OR
TOTAL
I 2/26
SMALL ENTITY
OR
OTHER THAN
SMALL ENTITY
RATE
addi- ;
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$ 9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
OR
TOTAL
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
ADDIT. FEE
OR
TOTAL
* If the entry in column 1 is less than the entry in column 2, write "0" in column 3.
** If the "Highest Number Previously Paid For" IN THIS SPACE is less than 20, enter "20."
***lf the "Highest Number Previously Paid For* IN THIS SPACE is less than 3, enter "3."
The "Highest Number Previously Paid For" (Total or Independent) is the highest number found in the appropriate box in column 1.
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$ 9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
ADDIT. FEE
OR
TOTAL
ADDIT. FEE
FORMPTO-875 (Rev. 8/01)
Patent and Trademark Office, U.S. DEPARTMENT OF COMMERCE
-ft-U.S OPO:2001 482-124/59197